Lithium prophylaxis of manic‐depressive disorder: daily lithium dosing schedule versus every second day

Abstract

The prophylactic efficacy of lithium carbonate given every second day versus daily intake was compared in a double-blind study including 50 manic-depressive patients. The patients met the DSM-III-R criteria for bipolar disorder or depressive disorder; according to ICD-8 the patients fulfilled criteria for manic-depressive disorder: All patients had experienced at least 3 episodes of mania or major depression, and all had been euthymic for at least 4 months. The median doses of lithium carbonate given were 800 mg/day or 1200 mg/every second day corresponding to median 12-h serum lithium concentrations of 0.6 mmol/l or 0.7 mmol/l, respectively. Manic or depressive relapse was defined as DSM-III-R criteria for mania or major depression, and a score > or = 10 on the Bech-Rafaelsen Mania Scale or the Bech-Rafaelsen Melancholia Scale, respectively. The two treatment schedules were allocated at random. Using the Cox proportional hazard model for statistical analysis, the lithium dosing schedule of every second day did not maintain its prophylactic efficacy against recurrent episodes of manic-depressive disorder. The risk of relapse increased 3 times when the interval between intake of lithium was extended from 1 to 2 days.

An Updated Review of the Optimal Lithium Dosage Regimen for Renal Protection

“…However, alternate-day dosing was found in one study to be less effective than SDD. 31 Many patients receiving lithium have other risk factors for renal disease, including nephrotoxic medications, age, comorbidities, long duration of lithium therapy, and possibly a prior history of lithium toxicity. 2 Although the exact degree of renal toxicity or optimal dosing regimen are not definitively known, there is evidence for a possible association between renal impairment and lithium therapy; therefore, prescribers should do their utmost to mitigate this potential risk by ensuring the lowest effective lithium dose is used, individualizing dosing regimens to minimize adverse effects, and regularly monitoring renal function and lithium serum levels to prevent episodes of toxicity.…”

“…31,32 Fifty patients treated with lithium were randomized to either remain on SDD, or receive lithium every second day alternating with placebo. No significant difference was found between groups regarding adverse effects; however, authors noted a trend toward reduced polyuria and polydipsia and less diarrhea in the alternate-day group.…”

Atypical Antipsychotic Usage-Related Higher Serum Leptin Levels and Disabled Lipid Profiles in Euthymic Bipolar Patients

“…according to the DSM-IV [30] . Euthymia was established as not having met DSM-IV criteria for any mood episode (a score ^ 9 on the BechRafaelsen Mania Scale [31] , and HAMD scores between 0 and 7 [32] 11 months, respectively. All subjects were evaluated by a semi-structured questionnaire.…”

A Case Report Showing that Subclinical Hypothyroidism Rather than Hyperthyroidism Stabilizes Rapidly Cycling Bipolar Illness

“…In a study comparing daily lithium dosing versus lithium dosing every second day, Jensen et al [9] showed that daily lithium dosing was clinically superior and that TSH levels in this group of patients were significantly highest.…”